EMT001

HAHA - actually, I didn't read the entire thread and had no idea that someone else posted that. Yes, I know it works. But, I said don't do it because most people do not have protocols to do it.

Stick it up their butt, squeeze. Just kidding, don't actually do that.

Not saying that you were were not telling the truth. I know NJ, trust me. Maybe we are talking about the same incident.

HAHA - I think a former NJ medic who now posts on this board can tell you a story about pronouncing in the back of an ambulance enroute to the hospital.

You can get online medical control in NJ. Just call either ARMC ED and ask to speak to a doc. This isn't done frequently, but it is an option. Chances are, and especially working in the city, that on a call where med control was needed, a medic unit would be on location also. Obviously, they could call control direct.

In New Jersey, you can drop off any infant at a hospital, firehouse, police station, or ambulance building and be free from prosecution. You actually have to leave it with somebody, you cannot just drop it off outside. I believe we call them "Safe Haven" laws.

You can have O2 and you can carry glucose. That said, why would you want too? Don't stop off-duty, ever.

There is no duty to act for off-duty personnel in New Jersey. What beach were you on?

Just curious, how did he say he broke his femur?

"Noelle if you don't shut up I swear to God I won't kill you". -- That is my favorite line from the movie. If you haven't already, you should watch the movie 'Hospital'. It is from the 1960's or 70's and is absolutely hilarious. There is one line, when a patient is explaining what he did when he escaped, where he says, "I hit the nurses call button and then went into the hallway." When they ask why he hit the call button, he replies "To ensure a half hour of uninterrupted privacy". -- HAHAHA

I hope the nurses at his hospital bludgeon him in his sleep. I have a patient that will call 911 for a ride to the ED because she is scared to be home alone when her husband is at work at night.

Just to clarify, I did ask about previous knee injury and precipitating factors that would account for the knee swelling. She had a previous injury to the knee and stated that it was a little more swollen then normal, but not too bad. There was a decrease in pn. and a significant improvement in sensation. Also, I was having the same thoughts as Rid about quad-muscle spasms and free bone ends moving around. Saw the doc this morning, classic midshaft femur fx. with no patellar involvement. Thanks for all the input.

Wanted to run this by everyone to see what you think. Had a run tonight where an elderly lady tripped and fell. She said her leg fell backwards and she heard a "pop". No LOC, No head, neck, or back pn. Only c/o (L) leg pn. When asked where the pn. is, she points midshaft femur. Good pedal pulses, decreased sensation. Obvious deformity midshaft femur, however the area around the lateral portion of the knee was also slightly swollen. No pn. to the hip or knee are on palpation however. The pt. stated that the only thing bothering her was the leg, which hurt a lot. I know injury to or around the knee cap is a contraindication for the traction splint, however I do not think this pt. had a injury to her knee. So, I applied the traction splint. Notable decrease in pn. and even an increase in sensation. Get to the ED, doc chews me out because the splint is on when there is swelling to the knee. I tried to explain everything that I stated above, but he wouldn't hear it. Just want to see what everyone else thinks/would have done. We are waiting on the X-rays to see if the knee was involved as well. No one is questioning that there was a femur fx.

Buses are a good idea, they are on the way. What about the Red Cross? Would you like them on scene for food and warm drinks? Someone mentioned setting up an efficient way to funnel transport units into and out of the scene without difficulty. The transportation officer (in the parking lot of the local mall) has a system that is working. He has a counterpart on the accident scene who radios him when treatment requests a rig. He sends the amount requested. You are now working your way through the accident. The local PD is interviewing patients to see how the incident occured. You really haven't had time for this yourself, and assumed that the accident was simply a factor of the driver taking the turn too hard. One of the passengers mention that the driver had gone into the bathroom on the bus before they left, and, at the time of the accident, had passed out. An additional passenger also notes walking into the bathroom, smelling a strange odor, and he too feels like he is going to pass out. Slowly, but surely, numerous passengers begin showing symptoms of some kind of exposure to a foreign agent. You halt rescue operations in the bus and have all possibly infected personnel cordoned off, away from responders in the staging area who have not entered. The local Hazmat team, which already happens to be on scene, springs into action. No one called for them, but like all giant incidents the cavalry has come. They enter the bus and discover a suspicious package. What is you next move. You've already sent all of the P1 patients out and are in the process of removing the P2's. (And no, this didn't actually happen. I had a boring shift the other day and tried to conjure up the worst incident I could imagine in my area.)

After your partner reports back, you realize the scope of the crap storm that you just walked into. You notify highway patrol that the ramp needs to be shut down. In addition to the EMS resources that you have responding, you request for the county task force to be activated. This will bring 35 BLS ambulances and 15 ALS ambulances. In addition, you ask your dispatch for medevac. Unfortunately, it is raining and all of the air services are grounded (welcome to my area). FD has arrived on scene and is determining extrication possibilities. The bus is unstable and will need to be cribbed before you can access the safety windows. The FD extrication team leader also suggests breaking the windshield so it will be easier to get people out of the bus, but it is your call. Local hospitals have been alerted. A level one trauma, 20 minutes away, can take 4 critical 15 minor; a level two trauma, 35 minutes away, can take 2 critical but 20 minor; a local ED, 10 minutes away, can handle no critical and 10 minor. The FD has finally cribbed the vehicle and entry is now possible. Simultaneously to cribbing you had you originally dispatched ALS buses set up triage and treatment areas. You have a transportation area established in a local mall parking lot not far from the scene, and all resources are being asked to stage there. Highway patrol has closed the ramp. A safety officer has been established and you still retain overall incident command. (You happen to be supervisor for the tour, lucky you.) When your triage team makes entry to the vehicle they find the following: 10 P1 patients, 20 P2 patients, 15 P3 walking wounded, and the driver is DOA. How do you direct resources? You have more critical patients than the ED's say they can handle. Do you divert a significant number of minor patients from one facility so another can handle more critical? Oh, and by the way, it is 40 degrees outside, your patients are getting cold, fast.